Guidelines for a Palliative Approach in Residential Aged Care

Guideline:
Nutrition
21. Good nutritional care requires an individualised approach that includes
early recognition of weight loss and the identification and management
of likely causes (e.g. adverse medication effects, poor oral health or
depression). This careful attention to assessment and management of
residents’ nutritional requirements improves quality of life.
22. Giving residents oral foods and fluid, even in small amounts, is
preferable to using more invasive enteral (e.g. nasogastric or PEG)
feeding methods. However, a dysphagia assessment is essential to
provide direction for oral feeding.
23. The aged care team member assisting with feeding should be seated at
eye-level with the resident and take time to establish and maintain a
relationship with the resident to create an atmosphere that is conducive
to relaxing the resident. This approach to feeding enhances the resident’s
nutritional intake and improves his / her social well-being.
6.4.2 Hydration
Ref No.
176
181
Evidence
level
II
IV
176 104 II
III-1
104 III-1
Dehydration is the loss of normal body water. It is a medical condition determined by chemical
tests and is usually treated by medical procedures. Dehydration should not be confused with
thirst. Thirst can be treated without medical intervention and generally does not respond to
medical treatments. Instead, thirst is best treated by small amounts of fluid or ice chips (finely
crushed) and careful attention to keeping the resident’s mouth and lips moist [185] (Level IV)
(See Section 6.9, ‘Mouth care’).
One study found no statistically significant relationship between the level of hydration of the
patient and symptoms such as feeling thirsty and having a dry mouth [201] (Level QE). The
authors suggested that artificial hydration may therefore be pointless in people with end-stage
disease whose bodies are shutting down.
A systematic review of the evidence for maintaining oral hydration in older people found that
there was insufficient evidence to determine the risk factors for dehydration and decreased fluids
or the optimum amount of oral fluids. More research is required to determine the optimum, noninvasive
method of maintaining adequate hydration in older people [202] (Level II).
Assessment
Dehydration has a variety of clinical signs, including dry skin and mucous membranes,
thickened secretions, decreased urine output, postural hypotension, headaches, cramps,
irritability, drowsiness, constipation, weight loss, disorientation and orthostatic hypotension
(changes in blood pressure due to postural change). [201] Many of these clinical signs occur for
other reasons, such as medication side effects, prolonged bed rest, mouth breathing and the use
of oral supplements [203] (Level QE). However, if several of these signs appear together or are
different from the resident’s usual presentation, dehydration may be the cause. Additionally,
when assessing the resident, the aged care team should be aware that clinical signs might not
Guidelines for a Palliative Approach in Residential Aged Care 93